1 9/12 year-old boy. Reoccurring respiratory infections. In the X-ray (sent to us from another clinic), segmental, basal opacities on the left side.

Pathomorphology or Pathophysiology of this disease :

Pulmonary sequester = "Rokitansky-lobe"Congenital malformation of the lung.A mass of non-aerated pulmonary tissue that is not connected to the normal bronchial tree. It receives its own blood supply from a systemic artery.In 65% of the cases in the left lobe, otherwise in the right, posterior lower lobular segment.Two forms:Intralobular (75-85%) - without own pleura, drainage into the pulmonary veins.Extralobular (15-25%) - with own pleura, drainage into the vena cava/azygos vein.

Radiological findings:

MRI 1: T2-HASTE coronal: conically configurated, ca. 4x2cm large structure in the left dorsobasal lung, In the T2-weighted image, an obvious signal intensity increase is seen.

MRI 2: T1-FLASH coronal with contrast: strong, homogenic, aortic synchronized enhancement of the sequestration after application of contrast. No aerated areas within this structure.

MRI 3: MRA (MIP-Projections): Proof of the systemic arterial vasculature from the aotra and the venous drainage in the hemiazygos vein.

MRI 4: MRA (MIP-Projections): Proof of the systemic arterial vasculature from the aotra and the venous drainage in the hemiazygos vein.

MRI 5: MRA (MIP-Projections): Proof of the systemic arterial vasculature from the aotra and the venous drainage in the hemiazygos vein.

Diagnosis confirmation:

Imaging including endoscopy

Which DD would be also possible with the radiological findings:

In obvious sequester-vascular supply: none.

Course / Prognosis / Frequency / Other :

Congenital deformity.Often secondary hematogenic infection with delayed healing and sustained inflammatory symptoms due to missing aeration (no self-cleaning).Mostly, surgical resection. Sometimes also prophylactically due to the danger of infection.

Comments of the author about the case:

The presented case is the classical example of a lung sequester. Here, probably an extralobular sequester.